Tweet This

In Part 1 of World TB Day coverage, I focused primarily on the scope of the problem and on North America. Here, we look at current issues more globally, focusing on Venezuela and North Korea.

A doctor examines a tuberculosis patient at a TB hospital on World Tuberculosis Day in Gauhati, India, Saturday, March 24, 2018. Earlier this month Indian Prime Minister Narendra Modi launched a campaign to fast-track the India's response to tuberculosis, which is now the world's leading infectious killer. (AP Photo/Anupam Nath)

While we often associate TB with distant lands in Africa and Asia, it is important to remember that TB also occurs in some parts of the Western Hemisphere. Peru has struggled with high rates of the disease for decades, and a disturbing example of how easily the disease can take off is Venezuela, which previously had been a model of good TB control.

Geneva needs to explain why this decision was reached, and how it will address the life-altering impact it will have on North Korean patients --especially those with multi-drug resistant tuberculosis who will die without medicine. A one-paragraph explanation on The Global Fund's website simply is not enough.

I wouldn't go so far as to say that this was a political move as a result of US-led efforts to squeeze the North Korean regime, but the timing of this decision begs the question of whether humanitarian aid is indeed being politicized.

even though the economy stabilized rather quickly (as you can see by the unemployment rate coming down), the TB rate stayed high. Then the MDR-TB rate continued to rise for another 10 years…even for an upper-middle income country like Russia (per capita GDP 20x North Korea), it's really hard to get the TB toothpaste back into the tube.

If this is what history has taught us about the spread of TB in middle-income countries, imagine how MDR-TB will take off in much poorer countries that lack even the most basic health infrastructure.

Also, we need to remember that new cases of TB may already be drug resistant, or MDR-TB. Both types are spread through the air or by coughs, especially in crowded quarters. Drug resistance is not increasing only because of patients not completing their treatment, but also because of conditions that allow for the spread of resistant strains, directly from one person to another. New MDR-TB cases are less that 3% in the U.S. and Canada, but 30+% in the former Soviet Union.

There’s a certain irony that this year’s World TB Day theme is “Wanted: Leaders for a TB-free world. You can make history. End TB,” given some recent political and funding decisions that will have a massive impact on public health. Most notably, there was the proposed 80% funding cut from the CDC budget and plan to close 39 of 49 offices overseas, where many of the serious infectious disease threats originate.

The rise in TB in each of these countries is a humanitarian disaster, born out of crowding, malnutrition and lack of care. Some might like to think that it can’t affect us here, but they will be sorely mistaken. One of the ironies is that while some fear immigrants from countries like India, China, and Brazil, which all have high rates of TB, those countries are also targeted to increase tourism by the U.S. and Canada, because their citizens tend to spend more compared to those of other countries and offer the best return on investment.

I am an Infectious Disease specialist, experienced in conducting clinical research and the author of Conducting Clinical Research, the essential guide to the topic. I survived 25 years in solo practice in rural Cumberland, Maryland, and now work part time as an Infectious D...